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Home My WebLink AboutTemp Food Inspection 297 Oakland Road TOWN OF SOUTH WINDSOR TEMPORARY FOOD EVENT INSPECTION SHEET Event Name: -Event Date: L I'l-L/I Location of Event: l` d1; 'ten Applicant/Coord.: :„ Ph.# gL 0-WN Email Address: Fax# QFO Name: Ph.# Email Address: Fax# METHOD: On-Site inspection Kitchen inspection Interview (Circle one) Food/Water Source Nle-r A-o pt�luc 2 vc'(N Approved source of food,%vholesome,free from spoilage Water source potable,from approved supply,food grade hoses-utilized Temperature Control Hot/cold holding equipment and temperatures adequate Food cooked/reheated to correct temperature Metal probe food thermometer(0-220F range)available/sanitized between use Accurate thermometers for all refrigerators Coolers(self draining) and ice packs/bags Hygiene/Handwashing Hats or effective hair restraints for food workers Hand washing station-warm water in jug w/spigot,liquid soap,paper towels Glovesh+or food handling,designated person to handle money Scoops to have handles Records Designated person in charge of food booth for each shift-logs kept General Food Protection No extensive food preparation/handling Food protected by wrapping, sneeze guards or other effective barriers Condiments single service,pump dispensers or squeeze bottles/shakers PHF hot held and not sold discarded daily or at end of event Food and single service food containers stored off floor Drinks stored in ice must be stored in self-draining storage containers Raw fruits and vegetables used in food prep to be washed in potable water Toilet Facilities/Waste Disposal Toilet facilities adequate, clean and conveniently located Waste water disposal container—disposed of properly Container for grease collection—disposed of properly Non-absorbent garbage containers, fly tight covers,Dumpsters must be covered Garbage containers and plastic bags Cleaning/Sanitizing Buckets/tubs for washing,rinsing, sanitizing food equipment(hot water) Bleach/Quat. for sanitizing, appropriate concentration,test strips available Utensils are to be sanitized every 4 hours or as needed Moist wiping cloths to be stored in container with clean sanitizing solution Storage/FB Construction All utensils/equipment to be properly stored to protect from contamination Chemicals to be stored separate from food products,bottles to be labeled Food booths constructed properly to protect food, adequate lighting provided COMMENTS: L,61 t t HEALTH INSPECTOR: A C, /L3 L Signature: a EVENT COORDINATOR: �VI s� Sig Lure:(if applicable) Date: "A temporary food service establishment serving food or drink shall comply with all provisions of Public Health Code 19-13-B42 which are applicable to its operation." April2011 4 VENDOR APPLICATION AND GUIDELINES FOR TEMPORARY FOOD SERVICE EVENTS t VENDOR APPLICATION FOR TEMPORARY FOOD EVENT The VENDOR of each temporary food event must complete this application and must be filed 14 days prior to the opening event. This application must be submitted to the Town of South Windsor Health Department, 1540 Sullivan Avenue, South Windsor, CT 06074. This apalication is not a license. Temporary food events will not exceed a period of 1 to 5 days. Today's Date June 23,2011 Name of Event Peace and Pancakes: Meditation Class followed by brunch Date of Event June 26,2011 Time of Event 10am-12:30pm Location of Event Odiyana Meditation Center,297 Oakland Road, South Windsor Event Coordinator Ryan Cronin Event Coordinator Address 92 Autumn Street,Manchester Event Coordinator Phone# 860-874-1970 Event Coordinator E-Mail Address admin@odiyana.org Event Coordinator Phone#(cell, work&home) same as above Name of Applicant Ryan Cronin Name of Applicants Business(please indicate if mobile vendor) Odiyana Meditation Center Applicants Address see above Applicants E-Mail Address see above Applicants Phone#(cell, work&home) see above Set up time Saturday,June 25, 1-3pm and Sunday,June 26, 8-loam Please provide the following: (If any of the following does not apply to you put N/A) 1. List all food and beverage items to be prepared and served(menu). Attach a separate sheet if necessary. NOTE: Any changes to the menu must be submitted to the Health Department 10 days prior to the event. - Pancakes—Batter mixed on site, cooked on electric griddle - Waffles—Batter mixed on site, cooked in waffle iron - Toppings (fresh fruit,maple syrup,whipped cream, powdered sugar, cinnamon) - Coffee - Tea - Sparkling Juice 2. Describe specifically how frozen, cold, and hot foods will be transported to the event. - Ingredients for pancakes and waffles along with other items will be driven from preparer's home,where all cold items will be refrigerated until the morning of the event. 3. List all places (hame&address)where meats,poultry, seafood, shellfish, and ice will be purchased. - N/A 4. List names,phone numbers, addresses, and shifts to be worked of all employees. See attachment#1. Attachment#1 5. Use Attachment#2 in this packet to sketch a drawing showing the event area and where your operation will be. Attachment#2 6. Describe the number, location and set up of handwashing facilities to be used by employees. - One handwashing sink near food prep area. Stocked with pump soap and paper towels. 7. Describe how and where utensil/equipment washing will take place. If no facilities are available, describe how alternate steps will be taken. - Dishes will be washed in 3 bay sink. One for wash, one rinse and one for sanitizing dishes. Appropriate concentration of bleach to water will be used in sanitizing bay. Dishes will air dry on drying racks. 8. Describe how wastewater will be collected, stored and disposed. - N/A 9. Describe the number and location of garbage containers. - 1 Garbage can located under countertop near bar 10. Describe what heat source will be used to keep hot foods hot(140 degrees and above). - Electric griddle and waffle iron will be used to cook items to order. No need to keep hot. 11. Describe how cold foods will be kept cold(45 degrees and below). - Refrigerator near food prep area. 12. Describe how food temperatures are monitored, cleaned and sanitized. - Thermometer in refrigerator. All fruit will be prewashed with gloved hands in sterilized rinse bay of 3-bay sink. 13. Will foods be prepared on site? If no,where will foods be purchased? (enclose copy of food license) - Yes. Some food purchased at East Hartford Shop Rite. t ATTACHMENT #1 NAME OF EMPLOYEE PHONE# ADDRESS SHIFT 1. Walt Butler 860-883-0676 5 Olde Flatbrook Road, East Hampton, CT full event 2. Kaitlyn Brayton 203-435-3077 90 N Turnpike Rd. Wallingford, CT full event 3. Thiemba Ferguson 860-798-7760 14 Cottage St.Windsor, CT full event 4. 5. 6. 7. 8. 9. 10. ATTACHMENT #2 CHECKLIST FOR FOOD BOOTH/VENDOR OPERATORS Metal probe thermometer(0—220 degrees F range) Thermometers for all refrigerators Coolers and ice packs (if ice is to be used for cooling of foods,where is water to be drained) Plastic wrap/Aluminum foil Extra utensils: tongs, spatulas, spoons, and knives Water source Buckets/tubs for washing,rinsing, sanitizing food equipment Bleach for sanitizing,test strips for checking Waste water disposal container Container(s) for grease collection Clean wiping cloths and a container to store them in Garbage containers and plastic bags Hats/hair restraints Crates, shelves to store food off of the ground Gloves for food handling Hand washing station Refrigerator Handwashing t Food Prep Dishwashing Emergency Exit and Restrooms Class Space O Trash Seating--- Front Door